上肢坏死性软组织感染：单中心 24 例研究。

Plastic and Hand Surgery Department, Charles Nicolle University Hospital, Rouen, France.

Plastic and Reconstructive Surgery, Toulouse University Hospital, Toulouse, France.

Hand Surg Rehabil. 2024 Jun;43(3):101718. doi: 10.1016/j.hansur.2024.101718. Epub 2024 May 21.

OBJECTIVES

Necrotizing soft-tissue infection and necrotizing fasciitis of the upper limb are infrequent. Studies are rare, and often include other anatomical regions. The specificities and particularities of this pathology are not well known. The aim of this study was to report diagnosis and treatment aspects.

METHODS

A retrospective study was conducted over 10 years on every patient treated for necrotizing fasciitis of the upper limb with clinical, bacteriological and histological confirmation. One hundred ninety-eight items were extracted for each patient concerning clinical, biological, radiological and therapeutic data.

RESULTS

During 10 years, 24 patients were diagnosed with necrotizing fasciitis of the upper limb: 18 males, 6 females; mean age, 59.9 years; mean body mass index, 25. Local erythema, pain and fever were the most frequent symptoms. Skin necrosis was present in fewer than 40% of patients. Sixteen cases (66.6%) had prior skin lesions and/or an entry point on the limb. Ten had non-steroidal anti-inflammatory drug prescription before acute symptom onset (42%), requiring intensive care unit admission. Treatment comprised surgical resection, resuscitative measures, antibiotic therapy and reconstructive surgery. Seven patients (30.4%) had 1 session of cutaneous excision, and the others had more than 2. Microbiological analysis found mono-microbial beta-hemolytic group A streptococci (BHGAS) infection in 14 patients (58.4%). Antibiotics were prescribed in 91% of cases before surgery, and in 100% after. The most frequently prescribed substance was clindamycin (18 patients, 75%). Ten patients (42%) stayed in the intensive care unit during treatment. Seventeen patients (70.8%) had thin skin graft reconstruction, including 50% with dermal substitute. Five patients (20.8%) had partial upper limb amputation. Two patients (8.3%) died in the 30 days following diagnosis.

CONCLUSIONS

The death rate in necrotizing fasciitis of the upper limb was rather low but the amputation rate was higher than in other locations. This study shows the specific clinical, biological and treatment features of this rare but serious pathology of the upper limb.

目的

上肢坏死性软组织感染和坏死性筋膜炎并不常见。研究很少见，并且通常包括其他解剖区域。这种病理学的特殊性和特殊性尚不清楚。本研究的目的是报告诊断和治疗方面。

方法

对 10 年来经临床、细菌学和组织学证实的上肢坏死性筋膜炎患者进行回顾性研究。每位患者提取 198 项临床、生物学、放射学和治疗数据。

结果

在 10 年内，24 例患者被诊断为上肢坏死性筋膜炎：18 例男性，6 例女性；平均年龄 59.9 岁；平均体重指数 25。局部红斑、疼痛和发热是最常见的症状。不到 40%的患者有皮肤坏死。16 例（66.6%）有先前的皮肤损伤和/或肢体上的入口点。10 例在急性症状发作前服用非甾体抗炎药（42%），需要入住重症监护病房。治疗包括手术切除、复苏措施、抗生素治疗和重建手术。7 例（30.4%）患者行 1 次皮肤切除术，其余患者行 2 次以上。微生物分析发现 14 例（58.4%）患者感染单微生物β-溶血性链球菌（BHGAS）。91%的病例在手术前和 100%的病例后开具抗生素。最常开的药物是克林霉素（18 例，75%）。10 例（42%）患者在治疗期间入住重症监护病房。17 例（70.8%）患者行薄皮移植重建，其中 50%患者使用真皮替代物。5 例（20.8%）患者行部分上肢截肢。2 例（8.3%）患者在诊断后 30 天内死亡。